The treatment of severely comminuted intra-articular fractures of the distal radius

Comminuted fractures of the distal end of the radius are caused by high-energy trauma and present as shear and impacted fractures of the articular surface of the distal radius with displacement of the fragments. The force of the impact and the position of the hand and carpal bone determine the pattern of articular fragmentation and their displacement and the amount and the extent of frequent concommitant ligament and carpal bone injury. The result of the osseous lesion in comminuted fractures was termed "pilon radiale", which emphasizes the amount of damage to the distal radius and the difficulties to be expected in restoring the articular congruity. Besides this the additional injury, either strain of disruption of the ligaments and the displacement of the carpus and/ or the triangular fibrocartilage complex will equally influence the functional outcome. This review will expand on the relevant anatomy, correct classification and diagnosis of the fracture, diagnostic tools and operative treatment options. Current treatment concepts are analysed with regard to actual literature using the tools of evidence based medicine criteria. A new classification of severely comminuted distal radius fractures is proposed using CT data of 250 complex intraarticular radius fractures. Finally a standardized treatment protocol using external fixation in combination with minimal invasive internal osteosynthesis is described

The “floating forearm” injury in a child: a case report

The case of a eleven-year-old girl who had a fracture dislocation of the left elbow with entrapment of the ulnar nerve into the dislocated ulnar epicondyle anlage and unstable forearm fracture of the ipslateral upper extremity is described. This severe injury to the elbow and the ipsilateral forearm is termed “floating forearm” injury. The forearm was stabilized percutaneously and the elbow fracture dislocation, remaining unstable after internal fixation was treated with a pediatric elbow fixator with motion capacity

Efficacy of the A-V Impulse System versus cryotherapy in the reduction of postoperative oedema of the hand: a prospective randomised trial

In a prospective randomised trial, the effects of an intermittent compression hand pump vs. cryotherapy were compared on reduction of postoperative hand swelling and gain in finger movement after distal radius fractures. Although intermittent compression as a physical method for thromboprophylaxis and swelling reduction in orthopaedic and trauma patients of the lower leg are established, a prospective randomised trial for an objective evaluation of the effects of intermittent compression in the upper extremity has not been previously performed. Forty-three subjects (63±33 years, 32 women, 11 men) with a unilateral distal radius fracture treated with transarticular external fixation were randomised into two treatment groups. In group A 21 patients were treated with cryotherapy. In group B 22 patients were treated with an intermittent compression hand pump. Reduction in swelling of the treated hand and MP and PIP joint movement were recorded with computerised assessment software (EVAL Hand Evaluation System) in comparison to the uninjured contralateral side. Reduction of swelling in group A was not statistically significant (28.5% of total swelling or 0.61 cm, SD 0.39, p=0.42), but in group B it was significant (92% of total swelling, 3.62 cm, SD 1.48, p<0.001). Comparison of increases in MP and PIP joint movement (p<0.0016) showed statistically significant differences in favour of the intermittent compression pump. This study demonstrates that intermittent compression is more effective in the reduction of postoperative oedema and gain of finger movement of the hand than cryotherapy

A hinged external fixator for complex elbow dislocations: A multicenter prospective cohort study

Background: Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures of the radial head, olecranon, or coronoid process. The majority of patients with these complex dislocations are treated with open reduction and internal fixation (ORIF), or arthroplasty in case of a non-reconstructable radial head fracture. If the elbow joint remains unstable after fracture fixation, a hinged elbow fixator can be applied. The fixator provides stability to the elbow joint, and allows for early mobilization. The latter may be important for preventing stiffness of the joint. The aim of this study is to determine the effect of early mobilization with a hinged external elbow fixator on clinical outcome in patients with complex elbow dislocations with residual instability following fracture fixation. Methods/Design. The design of the study will be a multicenter prospective cohort study of 30 patients who have sustained a complex elbow dislocation and are treated with a hinged elbow fixator following fracture fixation because of residual instability. Early active motion exercises within the limits of pain will be started immediately after surgery under supervision of a physical therapist. Outcome will be evaluated at regular intervals over the subsequent 12 months. The primary outcome is the Quick Disabilities of the Arm, Shoulder, and Hand score. The secondary outcome measures are the Mayo Elbow Performance Index, Oxford Elbow Score, pain level at both sides, range of motion of the elbow joint at both sides, radiographic healing of the fractures and formation of periarticular ossifications, rate of secondary interventions and complications, and health-related quality of life (Short-Form 36). Discussion. The outcome of this study will yield quantitative data on the functional outcome in patients with a complex elbow dislocation and who are treated with ORIF and additional stabilization with a hinged elbow fixator. Trial Registration. The trial is registered at the Netherlands Trial Register (NTR1996)

10 years German Society for Orthopedics and Trauma Surgery (DGOU): trauma surgery-quo vadis?

On the occasion of the 10th anniversary of the foundation of the German Society for Orthopedics and Trauma Surgery (DGOU), the current General Secretary of the German Society for Trauma Surgery sees the need for a standpoint on trauma surgery in Germany. This manuscript outlines future options and perspectives for the development of trauma surgery in Germany